Substance misuse in personality disorder and schizophrenia: findings and clinical implications from a high secure hospital
| Published date | 14 August 2017 |
| DOI | https://doi.org/10.1108/JFP-07-2016-0035 |
| Date | 14 August 2017 |
| Pages | 217-226 |
| Author | Alessandra Cappai,Jodie Wells,James Tapp,Derek Perkins,Anna Manners,Martha Ferrito,Nitin Gupta,Mrigendra Das |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
Substance misuse in personality disorder
and schizophrenia: findings and clinical
implications from a high secure hospital
Alessandra Cappai, Jodie Wells, James Tapp, Derek Perkins, Anna Manners, Martha Ferrito,
Nitin Gupta and Mrigendra Das
Abstract
Purpose –Substance misuse (SMU) is widely prevalent in mentally disordered offenders and is linked with
violenceand offending behaviour. Thereis however, a scarcity of literaturededicated to investigatingSMU and
its clinical correlates in relation to patients detained within high secure hospital settings. The purpose of this
paper is to investigate theextent and severity of SMU and correspondingtreatment needs in patients with a
primary diagnosisof personality disorder (PD) in comparison withmental illness (MI) in a high secure hospital.
Design/methodology/approach –The responsible clinicians of all patients (n ¼240) detained in a high
secure hospital were asked to record information using a SMU screening questionnaire over a ten-month
period. Details requested included substance type, history of past use and assessment and treatment needs.
Data were recorded and then analysed: descriptive statistics were conducted to report historical use of
substances, cross tabulations and χ
2
analysis explored the relationship between SMU and treatment status
and diagnosis and offending behaviour and a means comparison analysis was employed to explore length of
stay and treatment of SMU.
Findings –A total of 230 questionnaires were returned (95 per cent of the patient population). A history of
SMU was reported in 88.6 per cent of the sample, with alcohol and cannabis misuse being the most
prevalent. At least one substance had been abused by 74.3 per cent of the sample. In two-thirds of the
sample, SMU was linked with the onset of mental health problems and symptom exacerbation, including
violence. Interestingly, patients with a diagnosis of MI as compared with PD were more likely to have used
substances (93.3 per cent compared to 81.9 per cent) and were more likely to need treatment for SMU
(64.3 per cent compared to 36.8 per cent). In those with an MI diagnosis, SMU was more likely to be linked
with violence and index offence (74.3 per cent compared to 59.0 per cent).
Practical implications –SMU is significantly prevalent in high risk mentally disordered offenders and linked
to onset of mental health problems and offending. Patients with schizophrenia have a higher prevalence of
SMU than PD and are likely to be more in need of treatment. Violence and offending are more likely to be
related to SMU in schizophrenia than in PD.
Originality/value –This study substantiates existing evidence that SMU contributes to mental health
problems and criminogenic behaviour. Furthermore, the study reports new findings that characterize
differences of the relationship of SMU to offending in schizophrenia and PD in forensic psychiatric patients
presenting to a high secure hospital.
Keywords Personality disorder, Substance misuse, Schizophrenia, Offending behaviour, Mental illness,
Violence, Treatment needs
Paper type Research paper
Introduction
Previous evidence has demonstrated that the rate of substance misuse (SMU) within the
psychiatric population is considerably higher than within a general population (D’Silva and
Ferriter, 2003; Farrell et al., 1998). For forensic psychiatric patients, statistics are often even
higher, with rates among patients admitted to forensic units typically between 50 and 90 per cent
(Derry, 2008). There is no clear agreement with regard to the link between mental disorder and
Received 27 July 2016
Revised 27 September 2016
Accepted 25 October 2016
The authors’affiliations can be
found at the end of this article.
DOI 10.1108/JFP-07-2016-0035 VOL. 19 NO. 3 2017, pp. 217-226, © Emerald Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAG E 2 1 7
To continue reading
Request your trial